A quarter-century of plague an epidemic unending

Evidence points to AIDS epidemic peaking but no time soon

THE ENEMY: HIV has sparked the worst epidemic humankind has ever known.

Most Americans are already intellectually and emotionally disconnected from the first 15 years of AIDS. Even for gay men and lesbians who lived through those days of darkness, who witnessed the horror first-hand, the terrible reality has faded to a distant memory.

But the recent anniversary of the first published notice of the disease printed 25 years ago this month in the June 5, 1981, issue of Morbidity and Mortality Weekly Report calls us to somber remembrance of a time when hope itself seemed a fading mirage in the distance. And in the 15 years or so until the introduction of protease inhibitors in the mid-1990s, the disease ravaged the gay male community, nearly wiping out a whole generation of gay men.

The first report told of five young gay men in three Los Angeles hospitals who had developed an unusual cluster of symptoms. The men were not acquainted with one another, but the symptoms they developed were striking: all had Pneumocystis carinii pneumonia, an extremely rare form of the disease usually seen in cancer chemotherapy patients or organ transplant patients whose immune systems were artificially compromised to prevent organ rejection. All five also displayed candidiasis, a fungal infection of the mouth and throat, and cytomegalovirus, an agent well-known today to cause serious complications in AIDS patients.

The CDC followed up a month later with another report about gay men in California and New York who had contracted Kaposi’s sarcoma, a rare but fatal skin cancer associated with AIDS.

The condition had certainly been present earlier. Nobody knows for sure when or where, but the AIDS epidemic is thought to have begun in the dark forests of West Africa when a virus lurking in the blood of a monkey or a chimpanzee made the leap from one species to another, infecting a hunter.

Researchers have found HIV in a blood sample collected in 1959 from a man in Kinshasa, Congo. Genetic analysis of his blood suggested the HIV infection stemmed from a single virus in the late 1940s or early 1950s.

For decades at least, the early human infections went unnoticed on a continent where life is harsh and short.

Then came the CDC’s reports, marking a defining moment in the perception of the emerging epidemic.

In the early days of the epidemic, just the mention of AIDS elicited snickers and jokes. Few saw it as a major threat. It was the “gay plague,” and for some, divine retribution for a lifestyle Christian fundamentalists and other conservatives consider sinful.

When heterosexuals began to contract the disease through blood transfusions and other medical procedures, they were often portrayed as “innocent” victims of a disease spread by the immoral behavior of others.

Largely because of negative attitudes toward homosexuality, the new illness was largely dismissed, a concern only for scientists and the gay community. Even in scientific circles the malady was called GRID, for gay-related immune deficiency. It took gay activists more than a year to convince scientists to remove “gay” from the disease’s name, since the cause also existed in other at-risk people: hemophiliacs, Haitians, Africans. In 1982, the CDC re-named the disease, and it took the moniker it is known by today: acquired immune deficiency syndrome, or AIDS.

During these bleak early years, gay activists stood virtually alone in responding to AIDS. New organizations emerged to provide information and services in the hardest-hit communities. The Gay Men’s Health Crisis, the first community AIDS service provider in the United States, was established in New York City in 1982. In 1983, the National Association of People with AIDS was founded. That same year, a group of HIV-positive demonstrators forcibly took the stage at a U.S. health conference to issue a statement, referred to as The Denver Principles, setting forth the rights of people with AIDS.

All of this activity occurred below the radar of most Americans. The gay sponsors of these organizations raised their funds, wrote their bylaws, and carried out their missions virtually unaided. Then, in 1985, a fading matinee idol, Rock Hudson, seared the affliction into the collective conscience of America and the world. Hudson announced that he was HIV-positive and fled to Paris in search of treatment.

The haunting image of a critically ill Hudson being wheeled on a guerney from his chartered airliner, unsuccessful in his search for an extension of life in Paris, filled television screens and cemented in the nation’s psyche the hopelessness of an AIDS diagnosis.

“In a heartbeat, a generation of Americans was lost to AIDS,” said Joe Salmonese, president of the Human Rights Campaign.

But advances in medicine that have made the disease manageable in the developed world haven’t reached the rest.

AIDS could kill 31 million people in India and 18 million in China by 2025, according to projections by U.N. population researchers. By then in Africa, where the virus has wrought the most devastation, researchers said the toll could reach 100 million.

“It is the worst and deadliest epidemic that humankind has ever experienced,” Mark Stirling, the director of East and Southern Africa for UNAIDS, said in an interview.

Efforts to find an effective vaccine have failed dismally, so far. The International AIDS Vaccine Initiative says 30 are being tested in small-scale trials. More money and more efforts are being poured into prevention campaigns but the efforts are uneven.

Globally, just 1 in 5 HIV patients get the drugs they need, according to a recent report by UNAIDS.

Stirling said that despite the advances, the toll over the next 25 years will go far beyond the 34 million thought to have died from the Black Death in 14th century Europe or the 20 to 40 million who perished in the 1918 flu epidemic.

AIDS is the leading cause of death in Africa, which has accounted for nearly half of all global AIDS deaths. The epidemic is still growing and its peak could be a decade or more away.

In at least seven countries, the U.N. estimates that AIDS has reduced life expectancy to 40 years or less. In Botswana, which has the world’s highest infection rate, a child born today can expect to live less than 30 years.

Africa’s misery hangs like a sword over Asia, Eastern Europe and the Caribbean.

Researchers don’t expect the infection rates to rival those in Africa. But Asia’s population is so big that even low infection rates could easily translate into tens of millions of deaths.

Although fewer than 1 percent of its people are infected, India has topped South Africa as the country with the most infections: 5.7 million to 5.5 million, according to UNAIDS.

In the early years, too much time, money and effort was spent on the wrong priorities, Stirling said.

“Over the last 25 years, the one real weakness was the search for the magic bullet. There is no quick and simple fix,” he said. “But with the recent successes we are starting to see the end of epidemic.”

The pace of change over the last couple of years suggests the number of new infections can be reduced by 50 to 60 percent by 2020 if the momentum continues.